MEDICARE: DR. MICHAEL AMER NACKASHI PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	103TC0700X	Clinical Psychologist	PY11564	FL

General Provider Information

NPI Number	:	1508259920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL AMER NACKASHI PSY.D.

Provider Business Mailing Address
First Line	:	6058 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2358
Country	:	US
Telephone Number	:	904-379-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	6058 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2358
Country	:	US
Telephone Number	:	904-379-8094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	01/28/2023

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